Name *

First

Last

Company *

Phone

Email *

How would you rate the customer service experience overall? *

Not at all Likely Extremely Likely
0	1	2	3	4	5	6	7	8	9	10

How would you rate our timeliness of deliveries? *

Very Poor	Poor	Average	Good	Very Good	Excellent
Very PoorTimeliness of Deliveries Very Poor	PoorTimeliness of Deliveries Poor	AverageTimeliness of Deliveries Average	GoodTimeliness of Deliveries Good	Very GoodTimeliness of Deliveries Very Good	ExcellentTimeliness of Deliveries Excellent

How would you rate our after sales support? *

Very Poor	Poor	Average	Good	Very Good	Excellent
Very PoorTimeliness of Deliveries Very Poor	PoorTimeliness of Deliveries Poor	AverageTimeliness of Deliveries Average	GoodTimeliness of Deliveries Good	Very GoodTimeliness of Deliveries Very Good	ExcellentTimeliness of Deliveries Excellent

Why did you choose Aero Healthcare products? (You may select more than one option) *

• Quality
• Price
• Availability
• Customer Service
• Personal Recommendation
• Solutions Offered
• No Alternative Available

How would you rate the overall quality of Aero Healthcare products? *

Not at all Likely Extremely Likely
0	1	2	3	4	5	6	7	8	9	10

How would you rate the breadth of our range of Products? *

Not at all Likely Extremely Likely
0	1	2	3	4	5	6	7	8	9	10

How would you rate our packaging quality? *

Not at all Likely Extremely Likely
0	1	2	3	4	5	6	7	8	9	10

What are the biggest challenges you come across when selling Aero Healthcare products?

What new products you would like to see from Aero Healthcare?

How did you first hear about Aero Healthcare? *

• Online
• Facebook
• Linkedin
• Email
• Event
• Trade Show
• In store Display
• Magazine
• Distributor
• Word Of Mouth
• Sales Rep

How do you stay up to date with news from Aero Healthcare? (You may select more than one option) *

• Email
• Customer Service
• Website
• LinkedIn
• Facebook
• Online Store
• Other

How do you stay up to date with news from Aero Healthcare? (Other)

How would you like to be notified about updates? (You may select more than one option) *

• Email
• Text Message
• Phone Call
• LinkedIn
• Facebook
• Online Store
• Other

How would you like to be notified about updates? (Other)

What areas do we do well? (You may select more than one option) *

• Customer Service
• Product Knowledge
• Innovation
• Reliability
• Communication
• Product Quality
• Other

What areas do we do well? (Other)

What areas could we do better? (You may select more than one option) *

• Website Resources
• Marketing Collateral
• Staff Training
• Sales Support
• Product Quality
• Communication
• Innovation
• Other

What areas could we do better? (Other)

How likely are you to recommend Aero Healthcare? *

Not at all Likely Extremely Likely
0	1	2	3	4	5	6	7	8	9	10

What is the main reason you would only be this likely to recommend us??

What could we do to improve?

What is the main reason you would recommend us?

Would you be willing to provide us a testimonial? *

• Yes
• No

What would you like to see from Aero Healthcare that we're not currently doing?

Do you have any questions or concerns you would like to raise with us?

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